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Can LOBULAR CANCER be missed in PET scans?

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You always say that PET/CT scans are the gold standard of scans. But, my husband just found a lot of websites saying that pet scans don't enhance as much for lobular cancer (because of the way that lobular cancer metabolizes glucose). They work very well for ductal cancer. Apparently the lobular cancer also looks more diffuse, so that makes it even harder to see. Apparently the brightness only shows up 60% for lobular cancer and it is easy to miss things. Do you think this is true? My Pet/CT scan showed NO enhancement. But, now I am worried that there could be lobular cancer (small amount) in my liver or lungs that the PET part of the CT scan missed. Thank you!

Category: Oncologist

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Category: Hematologist
Dr. Prasad Eswaran is online now

Expert:  Dr. Prasad Eswaran replied 4 Days.

Hello and welcome back to DoctorSpring.com.

Presently PET/CT scan is the gold standard for malignancies generally.

Investigations have to be always correlated with the clinical conditions and other parameters. Physicians have to correlate everything with the presenting condition, clinico-radiologic and pathology investigations.

Internet gives you a whole lot of general, non-specific and sometimes inaccurate information causing unnecessary anxiety. 

Specifically answering your query, PET scan is done along with CT scan and images are correlated with overlapping the images. So if there was lobular cancer, it would have shown up on CT at least.

Hope your concern is addressed.

Let me know if you have any other query.

Kind regards.

Patient replied :

Thank you for your answer. It is very much appreciated. I was not too worried about metastases after I found out about my ALLRED score being so high. I decided that the AI's would make anything go dormant. What I am worried about is that there might be some tiny (microscopic) metastastis on the liver, lungs, or other organ right now. Then I take 4 months off, with NO systemic therapy to get my double mastectomy and my radiation. During that 4 months, couldn't something grow on the liver, lungs,etc.--and there would be nothing to stop it? Or is lobular cancer (grade 2) slow enough, that that would not happen? Or maybe after the 4 months it would still be microscopic (but a little bigger) and the aromatase inhibitors could still stop it?

Expert:  Dr. Prasad Eswaran replied 3 Days.


Usually NO grossly aggressive behavior of the tumor happens during the period off medications.
The ER positive tumors generally have an indolent behavior and grow very slowly. Moreover, chemotherapy might have already acted on these microscopic disease, if we assume that it was present. Hence there is no need to be concerned about the duration in which you go through surgery and radiation.
Tumors don't grow within 4 months. Lobular cancers with ER positivity are slow growing tumors. AI can handle even if the tumor is large until the hormone status is positive.
May be, you can start with AI during RT ! No harm ! No gain ! 
But please consult with your oncologist.
Kind regards.

Dr. Prasad Eswaran
Category: Hematologist
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
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